Q: My cousin called and said she was just diagnosed with sugar in her blood. Doesn’t everyone have sugar in their blood?

A: You are correct, we all have glucose (a simple sugar) in our blood; it is the most important source of energy for our cells. However, “sugar in the blood” is a colloquialism for diabetes mellitus (DM).

The human body regulates many of its most important systems by having both “on” and “off” mechanisms working in concert, allowing the body to rapidly and precisely control its response to stimuli.

Insulin is a major hormone to regulate the body’s metabolism, helping control both the storage and utilization of the major energy sources in the blood, glucose and lipids (fats, sterols, certain vitamins, other substances). Simplistically, insulin increases the use of glucose and inhibits the use of fat as an energy source. Insulin is produced in the pancreas and is released into the bloodstream in response to increasing levels of blood glucose as well as from other signals.

Balancing insulin are epinephrine (also called adrenaline), noradrenaline and cortisol, which are made in the adrenal glands and are part of the body’s response to stress (for example infections, fight or flight response and many other causes), glucagon (made in the pancreas), growth hormone (made in the pituitary gland in the brain) and likely other hormones and mechanisms. For example, gastric bypass surgery helps control blood glucose levels independently of improved control that may occur due to weight loss, suggesting another glucose control mechanism is affected.

DM is a disorder of abnormal energy metabolism, resulting in abnormally high blood glucose and lipid levels. It is diagnosed based on abnormal glucose levels of greater than 126 mg/dl on two or more tests or by a single level greater than 200 mg/dl. Pre-diabetes (glucose intolerance) is diagnosed by morning glucose levels between 100 and 125 mg/dl or a level of 140 to 200 mg/dl two hours after ingesting a specific amount of glucose.

DM is an extremely common chronic condition, affecting more than 1 in every 10 Americans. Although over 1 million new cases of DM are diagnosed every year, many people with this condition are unaware they have it. More than 55 million Americans have pre-diabetes, although this does not necessarily lead to diabetes; the Diabetes Prevention Program showed that with certain lifestyle changes, including modest weight loss, increased physical activity and behavior changes (reducing fat and salt intake), progression to DM can be delayed or averted in over 50 percent of pre-diabetics.

Fatigue and slow wound healing are early, but non-specific, DM symptoms. High glucose levels may overwhelm the kidney’s ability to reabsorb all the glucose. As glucose is “spilled” into the urine, it causes an increased need to urinate (polyuria) and increased thirst (polydipsia).

Complications of DM may include:

Page 2 of 3 - - Kidney failure: it’s the leading cause of kidney failure, affecting more than 45,000 Americans per year.

- Peripheral neuropathy: about two-thirds of diabetics develop this nerve condition causing pain and numbness in the feet and/or hands. This, in addition to the poor blood circulation and poor wound healing, makes DM the leading cause of non-traumatic amputations.

- Cardiovascular disease: diabetics have a two to four times higher risk of dying from a heart attack, and up to eight times higher risk of dying from a stroke.

- Death: diabetes is the seventh leading cause of death in the U.S.

- Other: DM is a leading cause of blindness, dental problems and problems during pregnancy.

DM is characterized into several types:

- Type II DM, which accounts for 90 percent to 95 percent of all cases of DM, is due to the body’s cells becoming resistant to insulin, so patients have relative insulin deficiency (they need higher levels of insulin to regulate their blood glucose). Type II DM has a genetic aspect; it runs in families and is more common in certain ethnic groups (for example, African Americans). Risk factors include being overweight, having sedentary lifestyles and having a poor diet. In fact, due to the increase of these risk factors in our population, the incidence of type II DM has doubled in the last 10 years. Most people with type II DM (about 60 percent) are controlled with oral medications (pills) that help their system increase its insulin production and better utilize insulin. About 10 percent to 15 percent use only insulin, another 10 percent to 15 percent use insulin and pills, and the rest use diet modification without medications.

- Type I DM (the more common type in childhood) accounts for 5 percent to 10 percent of all diabetics and is caused by failure of the pancreas to produce insulin, usually due to an autoimmune reaction (the body attacks its own pancreas cells). It occurs sporadically, does not run in families, and no specific risk factors or triggers have been identified. These patients require insulin injections to survive.

- Gestational DM is an abnormality of glucose metabolism triggered by physiological changes that occur during pregnancy, affecting 3 percent to 10 percent of pregnancies. The American Diabetes Association recommends that women should be screened for DM during pregnancy. Adequate treatment (determined specifically for a pregnant woman) can help prevent pregnancy complications (such as fetal death, premature delivery, large birth weight baby which may increase the risk during delivery, low blood sugar for the baby immediately after delivery and others). Although most women who develop gestational DM have their glucose levels return to normal after delivery, their lifetime risk for developing DM is higher.

Diabetics must ensure they follow a careful diet, closely regulating their caloric intake. They also need to monitor their blood glucose and adhere to their medication regimen (whether pills or insulin). Regular exercise, under the guidance of a health-care professional, is also important. Many new therapies have been developed, including glucose pumps, implantable glucose monitors and many new medications. To prevent/identify possible complications, regular checkups, including annual eye examinations, measurement of HgbA1c (a blood test that can measure “average” levels of glucose to determine if a patient’s blood sugars are overall well controlled) two to four times per year, foot examinations, dental examinations, blood pressure monitoring, cholesterol monitoring and urine checks should be done.

Page 3 of 3 - The ADA is a great resource. Visit www.diabetes.org for more information.